What is diabetic amyotrophy?

Christine Manga, a diabetes nurse educator, clarifies what diabetic amyotrophy is and the necessary information you need to know.

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Diabetic amyotrophy is also known as proximal diabetic neuropathy, ischaemic mononeuropathy, diabetic lumbosacral plexopathy, Bruns-Garland syndrome, to name but a few.

In 1890, neurologist Ludwig Bruns first described the condition in people with diabetes, usually poorly controlled. In 1955, another neurologist, Hugh Garland coined the term amyotrophy. For this article I will refer to it as diabetic amyotrophy.

What is diabetic amyotrophy?

Diabetic amyotrophy is a rare episodic and progressive form of diabetic neuropathy. It’s characterised by loss of unilateral (sometimes bilateral) proximal motor function, atrophy (wasting, shrinking) of muscles in the front upper legs, sensation of severe burning, weakness, and pain.

An extreme aching pain in the hips, thighs and buttocks are almost always present. This is often followed by weakness. Anywhere between 35 – 50% of affected people will report unintended weight loss. Getting up from a sitting position becomes difficult. This condition can be disabling with some people requiring wheelchair assistance for a time. Progression of diabetic amyotrophy is quick, taking a few months.


The causes are not fully understood. Possible causes include but are not limited to:

  • A sudden reduction in blood glucose levels of a person with chronically raised blood glucose levels
  • Initiation of anti-hyperglycaemic treatment
  • An immune mediated vasculitis causing ischaemic (insufficient blood supply) damage to the nerves, and it has also been referred to as idiopathic.

Who is at risk?

Almost 50% of people with diabetes will experience diabetic neuropathy. However, diabetic amyotrophy only affects approximately 0.8 – 1% of people with diabetes. It affects more people with Type 2 diabetes compared to Type 1.

Onset is usually during middle age but can be seen in younger individuals. Males over the age of 50 with Type 2 diabetes are the most frequently affected. Duration and severity of diabetes are not predisposing factors. People with good glucose control can also experience diabetic amyotrophy.

How is diabetic amyotrophy diagnosed?

Diagnosis usually consists of a thorough history taking and physical examination especially of the lower limbs as well as reflex testing. To exclude other conditions with similar symptoms, such as nerve compression, a process of elimination is used.

A lumbar puncture, nerve conduction studies, and MRI scans may be performed. A blood workup will be done to assess diabetes control, vitamin deficiencies and inflammation markers.


Treatment is pain management. However, it does not respond to conventional pain medication, rather anti-epileptic, antidepressants, such as amitriptyline, and nerve pain treatments. Recently steroidal medication has been used. It appears to increase recovery time but also causes an increase in blood glucose levels. There is still not enough evidence for its use. Good glucose control is to be strived for.

An improvement in diet, physical exercise, such as physio, and stopping smoking and alcohol aid in recovery. The physiotherapy can aid in nerve restoration.

Diabetic amyotrophy can lead to anxiety and depression. Education is of utmost importance, hence explaining the progression to possible severe disability, paraplegia, and extreme pain. Although, it will not reverse diabetic amyotrophy, regular foot examinations for injury, wounds and infection will prevent further complications. The goal of treatment is to improve quality of life.


Diabetic amyotrophy is self-limiting and the likelihood of full recovery is probable. The entire process takes a few months up to about two years. Sometimes, but not often up to three years. Reassurance and encouragement that it will resolve is vital.


There is no precise way to prevent diabetic amyotrophy. The principles used to prevent general diabetes complications should be adhered to, including smoking cessation, good glucose control, limit alcohol intake, maintain a healthy BMI and regular check-ups with your doctor, dietitian, and educator.

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.


Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

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